SWINE FLU 2#

By Dr Himanshu Gul Mirani

Emergncy Physician

-          Prevention

-          Treatment

PREVENTION:

A. Sanitation related recommendations:

Breaking the transmission cycle is the simplest key to prevent infection. Some useful tips are as below:-

1.       Since it’s transmitted by droplet mode – covering the nose and mouth while sneezing / coughing into a tissue and discarding the same at the earliest is important prevention tip.

2.       Practice good hand hygiene standards like washing hands after sneezing into them, after touching things that are possibly infected by droplets like table tops/ toys/ door knobs etc.

3.       Wash hands preferably with soaps or alcohol based hand sanitizers.

4.       Kids who are suspected to have flu like symptoms should take off from school (duration to be based on the individual case basis) to prevent spread to other vulnerable populace of school kids.

B. Vaccination:

There are special vaccines for HINI strain of influenza virus and they are available in 2 forms, viz.                                       1.) Inactivated virus vaccine, as an intramuscular injectable drug                                                                                                            2.) Live attenuated (weakened) vaccine  which is given as an intranasal preparation.

Parameter	Killed vaccine (injection form)	Live vaccine (intranasal form)
Target age group	Above 6 months of age	Between 2-49 years only
Safety in pregnancy	Safe	Contraindicated

Dose: Before 9 years of age 2 doses are recommended, 4 weeks apart. For others one dose would suffice. For citizens over 65yrs of age, special ‘high dose’ vaccines are available.

The quantity of drug dose is age dependent and varies with the manufacturer and hence needs to be cross checked prior to administration every time.

Site of injections: For kids up to 1 yr of age – anterolateral aspect of thigh is preferred, for others deltoid is the preferred site.

Targets populace:  Ideally everyone should get the vaccination at the earliest possible opportunity. Still the ‘high risk category’ of people has been defined -

-patients with lung/kidney/ heart disease;                                                                                                                              -people with compromised immunity;                                                                                                                                   -pregnant women;                                                                                                                                                                                                        -health care personnel;                                                                                                                                                                        -children and old people above 65yrs

Action: Immunity takes about 2 weeks to get established and lasts for 1 year

Contraindications:

- For killed virus vaccine (injectable): Egg allergy or previous allergic reactions to flu vaccine or its constituents; previous history of Gullian Barre syndrome.

Mildfebrile illness is not a contraindication for injectable vaccine.

- For live virus vaccine (intranasal) : kids below 2 yrs and adults over 50 yrs of age; pregnant women; patients with severe active febrile illness or compromised immunity with asthma/lung/kidney/heart disease; Egg allergy or previous allergic reactions to flu vaccine or its constituents; previous history of Gullian Barre syndrome.

Side effects: Usually there are very mild side effects which subside in a day or two.

Vaccine type	Side effect
Injectable form	Injection site pain, mild fever, mild abdomen pain
Intranasal form	Headache, running nose dizziness, sore throat, nausea

But very rarely there can be life threatening allergic reactions also.

Reasons for flu like complaints despite vaccination:

Swine flu vaccine does not protect against the other viral strains or viruses. The symptoms might be because the patient develops flu from some other strain of influenza or is infected with some other virus like rhinoviruses or the vaccine did not induce adequate immunity in the individual or the individual go infected within the 2 week period post vaccination.

TREATMENT:

1. Symptomatic medications: Paracetamol group of medicines for pain relief and fever management and OTC nasal decongestants are advocated for the patients with mild flu symptoms.

Adequate hydration status needs to be ensured.

2. Antivirals: Its recommended for high risk patients who present with flu-like symptoms; patients who have had contact with a known case and present with symptoms and are not previously immunized or are not have supposed to have had developed the required immunity post vaccination and have viral levels sufficient to cause their symptoms are advised to take antivirals.

The recommended antivirals are OSELTAMIVIR & ZANAMIVIR.

3.  In case of superimposed infections and sepsis, antibiotic cover may be needed.

SWINE FLU 1#

By Dr Himanshu Gul Mirani

Emergency Physician

-          Introduction

-          Symptoms and clinical signs

-          Transmission

-          Diagnosis

INTRODUCTION:

Swine flu (H1N1) cases are again raging Delhi and already 64 cases have been diagnosed and the cases are expected to rise. This article is aimed to give public awareness to the laymen about this disease condition and its possible treatment and prevention in a comprehensive way.

SYMPTOMS AND CLINICAL SIGNS:

Like most viral/ flu syndromes, Swine flu is characterized by fever, running nose, cough, body ache, fatigue with aches, decreased appetite, nausea/ vomiting, body rash, itchy eyes, sore throat. Most people with good immunity would be able to fight out the infection and the disease wont progress further.

But in a select few, it can also lead to severe life threatening complications and they might be the initial presenting features like severe dehydration, pneumonia progressing to septic shock, electrolyte imbalances, kidney function derangements etc.

TRANSMISSION:

Swine flu is transmitted by contact from the animals/ birds to humans or there is transmission among humans like that of most viral illnesses – air borne (droplet) transmission specially within 1 meter distance; by fomites like the table tops/ door handles etc touched by infected hands of the diseased.

DIAGNOSIS:

Most of the times patients don’t require diagnostic tests for flu per se and clinical judgment is resorted to for diagnosis. Once the influenza activity is documented at some place the need for corroboratory evidence is less as most cases are usually mild/moderate in symptoms.

Tests are not routinely advised, not only from the view of diagnostic accuracy of these tests (as there is a wide variation in the accuracy from 10-70%) leading to many positive cases being missed, but also from the economic logistics perspective. Also, the usual panels of immunofluorescence studies or Rapid influenza detection tests don’t include Swine flu strain in particular. During the influenza

The most accurate diagnosis for Swine flu is a type of nucleic acid study called real time-reverse transcriptase test (r-RT PCR) and viral cultures. They require special sampling and testing equipments.

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Injury - Bruise

A bruise is an area of skin discoloration. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin.
Bruises can last from days to months, with the bone bruise being the most severe and painful.

Causes

Bruises are often caused by falls, sports injuries, car accidents, or blows received by other people or objects.
If you take a blood thinner, like aspirin or warfarin, you are likely to bruise more easily.

Symptoms

The main symptoms are pain, swelling, and skin discoloration. The bruise begins as a pinkish red color that can be very tender to touch. It is often difficult to use the muscle that has been bruised. For example, a deep thigh bruise is painful when you walk or run.
Eventually, the bruise changes to a bluish color, then greenish-yellow, and finally returns to the normal skin color as it heals.

First Aid

1.       Place ice on the bruise to help it heal faster and to reduce swelling. Place the ice in a cloth -- DO NOT place ice directly on the skin. Apply the ice for up to 15 minutes per hour.

2.       Keep the bruised area raised above the heart, if practical. This helps keep blood from pooling in the bruised tissue.

3.       Try to rest the bruised body part by not overworking your muscles in that area.

4.       If needed, take medicine to help reduce pain.

Don’ts

·         DO NOT attempt to drain the bruise with a needle.

·         DO NOT continue running, playing, or otherwise using the painful, bruised part of your body.

·         DO NOT ignore the pain or swelling.

When to see a doctor

Call your health care provider immediately if you feel extreme pressure in a bruised part of your body, especially if the area is large or very painful. This may be due to a condition known as "compartment syndrome." Increased pressure on the soft tissues and structures beneath the skin can decrease the supply of blood and oxygen to the tissues. This is potentially life threatening and you should receive emergency care promptly.
Also call your doctor if:

·         You are bruising without any injury, fall, or other reason.

·         There are signs of infection around the bruised area including streaks of redness, pus or other drainage, or fever.

Severe Allergic Reaction -Anaphylaxis

Anaphylaxis is a severe and potentially life-threatening allergic reaction
Anaphylaxis occurs when your immune system has a severe reaction to an allergen. The reaction can lead to a sudden drop in blood pressure and restriction of the airways. These events can result in difficulty breathing, unconsciousness and, rarely, death.
You can be prepared to respond to anaphylaxis by knowing its signs and symptoms, and by carrying emergency medication with you, such as injectable epinephrine.
It's also important to do everything you can to prevent exposure to the allergens that you have identified as triggers for your allergic reaction.

Causes of anaphylaxis

Any substance that can trigger an allergic reaction can also cause anaphlaxis. Most common are:

• Foods, such as peanuts, walnuts, pecans, milk, eggs, fish or shellfish
• Medications, such as penicillin
• Insect venoms, such as bees or wasps
• Latex

Signs and symptoms of anaphylaxis

The signs of anaphylaxis occur within minutes or seconds after being exposed to an allergen.
The following signs and symptoms are a strong indication of anaphylaxis:

• Constriction of the airways and a swollen tongue or throat, that results in difficulty breathing
• A drop in blood pressure resulting in dizziness, fainting or shock.
• A weak and rapid pulse
• Hives and widespread itching
• Flushed or pale skin
• Nausea, vomiting or diarrhea

Risk factors for anaphylaxis

Most people with allergies never experience an anaphylactic reaction. However, having an allergy puts a person at risk of develop anaphylaxis.
If you have had an anaphylactic reaction before, you are at greater risk of having another reaction in the future. Anaphylactic reactions can also grow increasingly severe with each episode.

Treatment of anaphylaxis

There is no medication that will prevent someone from developing anaphylaxis. However, there are medications that control the reaction once it starts.
Epinephrine (adrenaline) is the drug most commonly used to treat anaphylactic reactions once they start. It must be injected into the muscle to be effective.
Medical personnel called in to respond to a severe anaphylactic reaction may give you epinephrine.
If necessary, a doctor or emergency medical team may perform cardiopulmonary resuscitation (CPR). They may also administer intravenous antihistamines and cortisone to reduce inflammation of your air passages and improve your breathing.
If you're with someone who has experienced anaphylaxis and shows signs of shock — pale, cool and clammy skin, weak and rapid pulse, shallow breathing, confusion, anxiety — follow these steps:

• Call  emergency medical help immediately.
• Check to see if the person is carrying special medications to treat an allergy attack. If so, administer the medication.
• Get the person to lie down on his or her back. Elevate the feet higher than the head to keep adequate blood flow to the brain, which will prevent fainting. Keep him or her from moving unnecessarily.
• Keep the person warm and comfortable. Loosen tight clothing and cover him or her with a blanket. Don't give the person anything to drink.
• If the person is vomiting or bleeding from the mouth, place the person on his or her side to prevent choking.

If the person isn't breathing or has no pulse, perform CPR.

Anaphylaxis prevention

The best way to prevent anaphylaxis is to avoid substances that you know cause this severe reaction. Follow these steps to help ensure your well-being:

• Wear a medical alert necklace or bracelet to indicate if you have an allergy to specific drugs or other substances.
• Keep a properly stocked emergency kit with prescribed medications available at all times.
• Alert your doctor to your drug allergies before having any medical treatment.
• If you are allergic to stinging insects, exercise caution when they're nearby. Wear long-sleeved shirts and trousers. Avoid bright colors and don't wear perfumes or colognes. Stay calm if you come in proximity to a stinging insect. Move away slowly and avoid slapping at the insect. Avoid wearing sandals or walking barefoot in the grass if you're allergic to insect stings.
• If you have food allergies, read the labels of all the foods you buy. Manufacturing processes can change, so it's important to periodically recheck the labels of foods you commonly eat. When eating out, ask about ingredients in the food, and ask about food preparation because even small amounts of the food you're allergic to can cause a serious reaction.